H5N1, Bird Flu Updates
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Tracking Bird Flu Cases
Bird flu deserves its own thread for tracking suspected and confirmed cases. It's not the pandemic virus, but it is still an ongoing and significant threat because of its...
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A 27-year-old man in eastern Cambodia has died of bird flu, the country's first fatality this year and its eighth since the virus started to sweep through Asia almost seven years ago.

Cambodia's Health Ministry said in a statement issued jointly Wednesday with the World Health Organization that the man in Prey Veng province died Saturday. It was the country's 10th human case of the disease.

MORE than 1,000 ducks and chickens in Prey Veng province's Kampong Leav district are believed to have died after contracting the A(H5N1) virus, known as bird flu, and a further 1,500 will soon be tested for the disease, a health official said Thursday, just over a week after a man from the same district became the eighth person to die of the disease since it was first detected in Cambodia in 2004.

Chhun Dy, the district's chief of animal health, said officials would await test results from the 1,500 animals before deciding whether to begin culling.

Sok Touch, director of the Health Ministry's Communicable Diseases Control Department, said officials had warned villagers to stay away from the area where the infected poultry died. Kao Phal said that area had been "cleaned".

via ida at bird flu information corner, a report from riau pos: sungaiapit, riau ::: bird flu spreads to other villages. excerpt:
bird flu h5n1 had spread to desa parit i/ii, desa harapan and kelurahan sungaiapit since it was firstly identified in desa lalang. until now, bird flu infected human suspect has reached nine victims. two of them are now being treated at arifin achmad hospital in pekanbaru, while others are refused to be hospitalized.

ida has another report, from west sumatera, about a widespread outbreak of b2b h5n1 and one suspected human case, an 11-year-old boy.

a farmer shows carcasses of two openbill storks among thousands which have died in ayutthaya's phak hai district. residents fear bird flu is the cause of the deaths. photo: sunthorn pongpao
a vast wasteland in tambon khok chang of ayutthaya is home to tens of thousands of asian openbill storks (nok pakhang). it is one of the largest flocks of birds in ayutthaya.

a few days ago thousands of asian openbill storks died without apparent cause.

residents are worried the flock might have been infected with the bird flu virus as phak hai district was one of many areas nationwide reported with the virus outbreak last year.

bird flu? given that most of the birds died, it is strongly suggestive of a highly pathogenic virus such as h5n1, & they are not denying that it is influenza.

Quote from www.recombinomics.com

eighteen out of 25 chickens were found dead in the northern town of binyamina on thursday, in what veterinarians suspect might have been caused by the bird flu.

laboratory findings have so far located the existence of one of the two proteins that are identified with the virus. final results are to be received later on thursday, and will indicate whether the second protein is also found in the chickens.

h5n1 in israel would not be a surprise. the h5n1 isolated in 2006 in israel and gaza were virtually identical to the h5n1 in egypt and djibouti (see satellite map). although only egypt reported h5n1 last season, it was likely present in all of the above countries last year. in late 2005, israel also reported a suspect case.

this season the h5n1 detection in birds and patients in egypt has increased dramatically in recent days (see satellite map) and h5n1 has also been common in saudi arabia. there have also be reports (and denials) of h5n1 in iran.

the israelis are confirming that it is h5n1 & resulting from bird migration. dr. niman's commentary suggests that it is the fujian strain with uvs lake in mongolia as point of origin, & that it has moved into the middle east in the past year.

Quote from www.recombinomics.com

two emus that died thursday in kibbutz ein gedi's menagerie succumbed to a deadly strain of the avian flu virus, israel radio reported.

the above comments confirm h5n1 in an israel petting zoo. the suggestion that the emus were infected by migratory birds raises concerns that the fujian strain (clade 2.3.2) may have migrated to the middle east. earlier this year israel reported another outbreak of h5n1, which also raised concerns that the fujian strain had migrated into the area.

a year ago fujian h5n1 was found in migratory birds at uvs lake setting the stage for migration south in 2009, and a return in the spring of 2010. the above infection may signal that migration.

The lower case fatality ratio (CFR) in Egypt sounds optimistic, doesn't it? That is until you realize that it probably indicates increased transmission of a disease, many strains of which are deadly. Its impressive host range includes birds, dogs, cats, pigs, ferrets, humans, donkeys, and probably many other species that we are unaware of yet. Donkeys? Who knew? But, maybe it is not so surprising since after all, H3N8 jumped from horses to greyhounds, and this is just another flu...

Just prior to the first news of the initial swine flu cases in North America, virologists were becoming alarmed about the situation in Egypt, and puzzling over the increasing number of cases in toddlers. Why were the adult cases continuing to die, & why were we seeing case after case of benign disease in toddlers? We heard something about WHO sending a team into Egypt, but instead with no warning, Mexico happened. So, we are still left with this ongoing mystery, and left to wonder what it means. Is this cause for concern? Maybe.

Quote from www.recombinomics.com

NAMRU-3 has recently released HA and NA sequences from recent H5N1 cases in Egypt (11 from 2009 and 12 from 2010). All 23 HA sequences had 125del (3 BP deletion), indicating the deletion is becoming fixed in human H5N1 in Egypt. An earlier paper, “Characterization of conserved properties of hemagglutinin of H5N1 and human influenza viruses: possible consequences for therapy and infection control” had noted similarities between H5N1and seasonal H1N1, raising concerns of increased human transmission (H2H) of H5N1 with 125del. This concern was increased by the recent paper describing the detection of H5N1 in donkeys and serological evidence of widespread H5N1 antibodies in donkeys.

Concerns of human to human H5N1 transmission in Egypt were raised when mild cases in children were reported in the spring of 2007. Several had the 3 BP deletion and sequences were closely related. There children had a mild course, which did not include pneumonia.

In early 2009, mild cases were reported in toddlers. The large number of cases reduced the case fatality rate for H5N1 in 2009 to approximately 10%. The sequences from these toddlers also had 125del, which was followed by the most recent 23 sequences which were from the summer of 2009 to March 31, 2010.

...Egypt does not H5N1 test patients who do not have a poultry contact, the full extent of H5N1 remains largely unknown. Serological testing has been discussed for over a year. During that time a serological survey on donkeys was conducted, which showed widespread antibodies in donkey serum.

Results for a comparable test in humans, using a 125del H5N1 target is long overdue.

As I first read this commentary, I wondered why a Chinese lab would be sequencing virus from Egyptian poultry, & I still wonder how they even received the samples to do so. I was not aware that birds from China actually do migrate down to Egypt & presumably back again. Who knew? I think that what Dr. Niman is suggesting is quite possibly correct given this information.

Quote from www.recombinomics.com

China's national labs in Harbin released 10 HA sequences from Egyptian poultry, including 2 from 2010, 2 from 2009, and 6 from 2008. None of the sequences had 125del. However, one, A/chicken/Egypt/36-4/2008, had a deletion in the HA cleavage site that matched the Fujian sub-clade (2.3.2) found in wild birds at Uvs lake as well as the 2008 outbreak in Japan, South Korea, and Russia. The cleavage site and flanking region covering 200 BP matched clade 2.3.2 isolates indicating these polymorphisms were acquired by homologous recombination.

The movement of Fujian clade 2.3.2 sequences into Egypt was not a surprise. In early 2008, clade 2.3.2 was in wild birds in Japan and eastern Russia, followed by wild birds at Uvs Lake in 2009. Birds from Uvs Lake migrate through Egypt, leading to dual infections and acquisitions via recombination.

It is unclear why there are not more examples in the Middle East. However, the recent report of wild bird H5N1 sequences in Emus at an Israeli petting zoo suggests Fujian H5N1 clase 2.3,2 may have been recently detected.

At least 750,000 chickens will be slaughtered and destroyed in the Tulkarem-area town of Bal'a, as a heavy Palestinian police presence surrounded the area, ensuring area birds diagnosed with bird flu were not transported out.
The village, which exports between 4-5,000 cartons of eggs per day to areas in the West Bank, and hundreds of pounds of meat, will have its poultry stock wiped out following the discovery of bird flu by PA officials from the Ministry of Agriculture.
No human cases of the influenza virus have yet been reported, but officials said they are monitoring the area heavily to ensure proper containment mechanisms are put in place.

The World Health Organization released an updated map today showing the locations around the world where laboratory confirmed cases of H5N1 has been detected in humans.

Although it is entirely likely that some human infections have escaped detection, the few seroprevalence studies conducted in H5N1 hot-zone countries indicate that the virus remains difficult to catch, and only rarely has it been demonstrated to have been transmitted from one person to another.

That could change at any time, of course, if the virus should mutate into a more human adapted form.

Epidemiological comments
The layers started to show clinical signs on 27 April 2010 and from 28 to 29 April 2010 two layers died. The first two dead poultry were submitted to the National Avian Influenza Laboratory. At the laboratory, necropsy of the two whole carcasses was performed as well as rapid test to detect influenza A and H5; results were slightly positive for avian influenza. Movement control measures of poultry and poultry products were effective.

From 1 to 5 May 2010, the mortality of the poultry increased drastically in the farm and the farmer sent some more whole carcasses to the laboratory. The samples were tested using rapid test and were positive for influenza A and H5. On 6 May 2010, the samples were retested for confirmation using real-time PCR and results were positive for highly pathogenic avian influenza H5N1.

Actions for containing the spread of the infection were applied such as culling of infected and potentially infected poultry and disinfection of the premises; both were completed on 7 May 2010. Active and passive surveillances are on-going within 5 km radius around the infected farm. In addition, movement control is also effective.